Suggestions

[jay727]

I been having this pain in the back of my head for about 5 months now. I been to every doctor and no one can tell me what it is. I took a mri every thing came back fine. Its like a sharp pain in the back of my head and it only goes away when iam laing down. I went to a neurologist and he gave me prescription Amitriptyline but it is not helping. If anyone can tell me what to do i would appreciate because i dont know what else to do.

[jay727]

Do you know any good neurologist i can see i realy dont like the one iam seeing now. i got insuance i try any that good.

[Joyce K Lee, MD]

Dear jay727,

Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am limited in not having the opportunity to perform a full neurologic examination on you, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

To begin, head pain is a very common we see in our neurology clinics.
I would venture to say that for the most part this symptom tends to be a benign one.
There are rare occurrences where they tend to be more complicated.

To give you an idea of how extensive the differential diagnosis can be of this symptom, please review the following list:
1) Infection
Common cold
Flu
Fever - headaches are common with fever from any type of infection
Ear infection
Tooth infection (type of Dental conditions)
Sinus infection
Pneumonia
Measles
Mumps
Tonsillitis
Sinus blockage
Coughing - too much coughing can cause a form of traction headache.
Various possible types of headache:
2)Migraine
3)Cluster headache
4)Tension headache
5)Lifestyle causes
Hangover
Excessive alcohol
Stress
Fatigue
Tension
Tiredness
Excessive smoking
6)Dyspepsia
7)Eye conditions
Glaucoma
Eyestrain
8)Spinal tap treatment
Epidural - this anaesthetic procedure (common for childbirth) can occasionally cause damage to the spinal area and cause headache.
9)Systemic or metabolic conditions
Hypertension
Thyroid disease
Anemia
Kidney failure
Uremia
10)Lead poisoning - or mild lead exposure from paint or car
11)Various toxins - see toxin causes of headache
12)Brain or head conditions
Meningitis
Encephalitis
Head injury
Brain injury
Mild traumatic brain injury
Concussion
Temporal arteritis
Heatstroke
Sunstroke
Blood clots - in the brain, these can cause a stroke.
Brain aneurysm
Subdural hematoma
Stroke
Transient ischemic attacks
Subarachnoid hemorrhage
Brain tumor
Benign intracranial hypertension
Trigeminal neuralgia
13)Psychogenic pain syndromes
14)Congestion
15)Hyperemia
16) Dental conditions
17)Ear conditions
18)Nasal conditions

The list remarkably goes beyond the above list!

The reassuring thing in your particular case is that your MRI was normal.

I am comforted in knowing that you have already seen a neurologist for your pain.
Based on the medication recommended, I am assuming that your neurologist was thinking along the lines of one of the benign forms of headache -- either migraine or tension type headaches.

We use Amitriptyline often to treat headaches.
It is a tricyclic antidepressant drug.

In my clinical practice, it is very effective in decreasing the severity and frequency of many different types of headaches.
You should be aware however that the common side effects of using amitriptyline are extreme weight gain, drowsiness, nervousness, dizziness, and insomnia. Some rare side effects include tinnitus, hypotension, mania, psychosis, anticholinergic effects, heart block, arrhythmias, extrapyramidal symptoms, depression, and hepatic toxicity.

I'm not sure when you started this medication, but you should allow at least 4-6 weeks of usage before dismissing it as ineffective.

To tell you the truth, headache neurologists diagnose the types of headaches based on history and response to certain medications.
There is not a laboratory test of a specific diagnostic test that can differentiate one headache from another -- we use them to rule out the bad causes of headache (like a bleed or a stroke.)

If you are still in distress, please make it a point to go back to see your neurologist.
He can then prescribe a different type of medication that may be more effective for your pain.

Hope this helps,
JKL, MD